Anastasilakis Konstantinos, Symeonidis Chrysanthos, Kaprinis Konstantinos, Mataftsi Asimina, Tzamalis Argyrios, Dimitrakos Stavros A
2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Macedonia, Greece.
Case Rep Ophthalmol. 2011 Apr 22;2(1):129-33. doi: 10.1159/000328385.
Occurrence of choroidal neovascularization (CNV) during pregnancy has been reported as a complication of presumed ocular histoplasmosis syndrome or punctuate inner chorioretinopathy. To our knowledge, idiopathic CNV (ICNV) during pregnancy has only been reported once in the relevant literature. Bevacizumab has been used for the treatment of ICNV in small case series. However, there is limited experience regarding the use of ranibizumab for the management of ICNV.
A 31-year-old woman in the eighth month of her second pregnancy was diagnosed with mild macular and papillary edema. She was followed up using biomicroscopy, fluorescein angiography (FA), and optical coherence tomography (OCT). After 3 months, visual acuity further deteriorated and funduscopy, FA and OCT findings revealed a juxtapapillary choroidal neovascular membrane (CNVM). After two ranibizumab injections, best-corrected visual acuity increased significantly, physiological macular anatomy was restored and no subretinal fluid was observed.
In this case report, we present a young pregnant patient with peripapillary ICNV and neurosensory detachment involving the macula, and treatment of the eye with intravitreal ranibizumab following uneventful delivery. Increased angiogenic factor levels associated with pregnancy may contribute to the onset of CNV although this relationship has to be investigated experimentally. The rapid response to ranibizumab suggests that this anti-VEGF agent may be an alternative treatment option in the management of peripapillary ICNV.
妊娠期间脉络膜新生血管（CNV）的发生已被报道为推测的眼组织胞浆菌病综合征或点状内层脉络膜视网膜病变的一种并发症。据我们所知，妊娠期间特发性CNV（ICNV）在相关文献中仅被报道过一次。贝伐单抗已用于小病例系列中ICNV的治疗。然而，关于雷珠单抗用于治疗ICNV的经验有限。
一名31岁处于第二次妊娠第八个月的女性被诊断为轻度黄斑和乳头水肿。使用生物显微镜检查、荧光素血管造影（FA）和光学相干断层扫描（OCT）对她进行随访。3个月后，视力进一步恶化，眼底镜检查、FA和OCT检查结果显示在视乳头旁有脉络膜新生血管膜（CNVM）。在注射两次雷珠单抗后，最佳矫正视力显著提高，黄斑的生理结构得以恢复，且未观察到视网膜下液。
在本病例报告中，我们介绍了一名年轻的妊娠患者，其患有视乳头旁ICNV并伴有黄斑区神经感觉层脱离，在顺利分娩后对其眼内注射雷珠单抗进行治疗。与妊娠相关的血管生成因子水平升高可能促使CNV的发生，尽管这种关系有待通过实验研究。对雷珠单抗的快速反应表明，这种抗血管内皮生长因子（VEGF）药物可能是治疗视乳头旁ICNV的一种替代治疗选择。
